This study aimed to identify risk factors for Helicobacter pylori (HP) infection in children with peptic ulcers and to examine the associated changes in blood routine indexes. A total of 173 children diagnosed with peptic ulcers in our hospital between January 2017 and January 2022 were included in the study. All participants underwent the 13C rapid urea breath test to detect HP infection. Additionally, routine blood tests were performed to analyze the blood routine indexes. A questionnaire was administered to collect data on hygiene habits and family income, which were then correlated with HP infection. The analysis revealed several significant findings. The following risk factors were identified as independent factors for HP infection in children with peptic ulcers: poor economic conditions (odds ratio [OR] = 2.54, 95% confidence interval [CI]: 1.36-4.72), small per capita living area (OR = 1.93, 95% CI: 1.12-3.34), the use of family-shared tableware (OR = 2.17, 95% CI: 1.25-3.77), poor parental hygiene habits (OR = 2.08, 95% CI: 1.19-3.63), and a family history of ulcer (OR = 1.89, 95% CI: 1.08-3.29). HP-positive patients exhibited significant differences in blood routine indexes compared to HP-negative patients. Specifically, they had lower RBC count (mean difference = -0.82, 95% CI: -1.45 to -0.19), lower Hb level (mean difference = -0.61, 95% CI: -1.12 to -0.10), lower HCT level (mean difference = -1.08, 95% CI: -1.82 to -0.35), and higher platelet count (mean difference = 36.72, 95% CI: 8.21-65.23). This study provides important insights into the risk factors associated with HP infection in children with peptic ulcers and highlights the changes in blood routine indexes that occur with the infection. The identified risk factors, including poor economic conditions, small living area, family-shared tableware, parental hygiene habits, and family history of ulcer, can guide preventive strategies and interventions for HP infection in children. The findings also emphasize the significance of age as a factor in HP infection rates. Moreover, the observed alterations in blood routine indexes indicate the impact of HP infection on immune function in affected children. This study contributes to the understanding of HP infection in children and offers valuable implications for clinical practice, enabling better prevention and control of HP infection in this vulnerable population. children with peptic ulcer, Helicobacter pylori, blood routine test, risk factors.

We aimed to better understand patients' perspectives on Helicobacter pylori (H. pylori) treatment to develop tailored interventions for improving adherence. We conducted a qualitative study using semi-structured, in-depth interviews from September to December 2024. The study was conducted at a large, university-affiliated healthcare centre which provides comprehensive health check-up services to a geographically diverse adult population. Individuals aged between 35 and 65 years old who had tested positive for H. pylori infection by 13C urea breath test in two consecutive annual health screenings and who had received their most recent H. pylori screening results within the past 6 months were enrolled. Of the 23 participants involved in this study, 13 (56.5%) were male, with age ranging from 39 to 62 years. Five key themes emerged from the analysis: (1) Participants perceived H. pylori as common but not serious, with limited understanding of its association with gastric cancer, (2) Physician recommendations and familial concerns acted as primary cues to treatment initiation, (3) Barriers included low perceived severity, reinfection concerns, side effects, time constraints and absence of symptoms or family history, (4) Adherence was challenged by treatment side effects and lack of follow-up testing and (5) Despite low treatment completion, participants reported engaging in preventive behaviours such as using separate utensils and reducing dining out. Barriers to H. pylori eradication among health screening populations are multifaceted, involving informational deficits, cultural dining norms and logistical hurdles. Interventions should enhance physician-patient communication, emphasise follow-up testing and address misconceptions about reinfection and disease risk. Strengthening general practitioners' capacity for evidence-based H. pylori management and integrating post-screening educational support are essential for improving eradication rates and reducing infection-related morbidity.

Biomarkers in Irritable Bowel Syndrome: Rationale and Practical Use.

Influence of a 12week at-home resistance exercise program on 13C-glucose metabolism in patients with metabolic myopathies.

Beneficial effects of a compound probiotic in Helicobacter pylori-infected patients aged over 40 years: An open-label randomised clinical trial.

To explore the correlation of tea consumption with risks of gastrointestinal diseases using a risk prediction model integrating interpretable machine learning and a large language model. A survey was conducted among the patients undergoing both gastroscopy and 13C-urea breath testing at Gastrointestinal Endoscopy Center of Anxi Hospital of Traditional Chinese Medicine. Univariate analysis was performed to determine the suitability of feature selection. The collected data were randomly divided into training and testing sets in a 7:3 ratio. Support Vector Machine (SVM), K-Nearest Neighbors (KNN), Logistic Regression (LR), Random Forest (RF), Extreme Gradient Boosting (XGB), and Deep Neural Network (DNN) were applied to identify the best classifier for predicting high-risk gastrointestinal conditions. Bayesian optimization algorithm was used to obtain the optimal hyperparameter combinations for the 6 models. After Model fitting, the interpretability of the best models was analyzed using SHapley Additive exPlanations (SHAP). The DeepSeek-R1 base language model was fine-tuned with gastrointestinal disease dataset and Chinese medical online consultation data to obtain the final model. The study included 503 participants. All the selected features showed association with gastrointestinal diseases, but only age exhibited a significant linear correlation (β=0.023, SE=0.008, t=2.942, P=0.003). DNN model performed the best with a good accuracy (0.68), precision (0.68), recall rate (0.85), F1 Score (0.75), and AUC (0.74). The top 3 important features were age, DOB value, and smoking history. The large language model constructed provided recommendations consistent with those of professional physicians based on gastroscopy results. DNN model is effective for predicting gastrointestinal disease risk and offers reliable support for clinical risk assessment and decision-making regarding endoscopy. Smoking cessation, moderate alcohol consumption, and reasonable tea intake may help prevent gastrointestinal diseases.

In at least 18 states in the USA, law enforcement officers draw blood from motorists they suspect of driving while impaired. This article presents a conceptual and theoretical investigation of law enforcement phlebotomy, a novel example of the blurred boundaries between healthcare and policing in the medico-legal borderland. As law enforcement's logics of security collide with healthcare's logics of care, the impaired driver becomes the patient/suspect, a fraught subject position produced by the coalescence of two dissimilar professional dispositions in the law enforcement phlebotomist. The vulnerability of the patient/suspect subject position demands from the law enforcement phlebotomist the same level of care provided by clinicians in healthcare settings. Although curbing impaired driving should continue to be a national priority, this tool of police power deserves scrutiny.

Cigarette smoking is the leading cause of preventable death in the United States. We evaluate the feasibility and acceptability of a digital contingency management intervention for tobacco cessation among Medicaid beneficiaries with a pilot microrandomized trial. Participants (N = 37; 63.9% annual income <$15,000), self-enrolled across community-based health centers, were incentivized monetarily to submit breath samples twice daily for 4 weeks, with additional incentives for negative samples (≤6 parts per million carbon monoxide). Participants were randomized twice daily with fixed probability to be sent motivational messages or not manually through an app. We evaluate acceptability and feasibility of the program. Using a generalization of regression suitable for a binary outcome, we examine the average effect of delivering a message (vs. no message) on proximal sample submissions and smoking status. Thirty-three participants who completed a posttest assessment (97.1%) reported they would recommend the program to others. Participants submitted 69.5% of the expected samples (1,440 of 2,072 total) where 66.7% (960 of 1,440 total) of submissions were smoke negative. At the postintervention breath test, 61.3% (19 of 31 who submitted a breath sample) had a negative sample (i.e., 51.4% of all 37 participants). After adjusting for previous sample submission, participants were 7% more likely (risk ratio 1.07; 95% confidence interval [1.01, 1.14]) to submit a sample after a motivational message was delivered (vs. not delivered). The results support the incorporation of motivational messages into research involving contingency management for tobacco cessation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Small intestinal bacterial overgrowth (SIBO) is an increasingly recognized condition that influences immune responses. It may be linked to atopic disorders such as bronchial asthma (BA), food allergies (FA), chronic spontaneous urticaria (CSU), and mast cell activation syndrome (MCAS). The aim of our study was to perform a structured literature search to assess the possible correlation between SIBO and the presentation of atopic disorders. The prevalence of SIBO was highest in patients with BA (60-100%) and FA (50-87.5%), followed by MCAS (30.9%) and CSU (27.9%). The diagnosis of SIBO was based on lactulose or glucose breath tests. SIBO exacerbated symptoms of atopic diseases, and treating it within BA and MCAS improved the symptoms, in contrast to CSU. The present evidence suggests a possible crosslink between SIBO and atopic manifestations. Bacterial overgrowth appears to trigger the Th2 immune response via the mucosal pathway and low-grade endotoxemia. These result in the increased synthesis of interleukins involved in allergic reactions (IL-4, IL-5, IL-13). Further studies are essential to confirm the clinical significance of this association. The "gut-allergy axis" may offer new therapeutic options and possibly improve quality of life in patients with atopy.

Bloating and breath tests: A pragmatic approach.

Background/Aims: Vonoprazan 20 mg twice daily is effective for Helicobacter pylori (H.pylori) eradication, but studies on the efficacy of 20 mg once daily are limited. The efficacy, tolerability, and cost-effectiveness of bismuth-based quadruple therapy with vonoprazan 20 mg once daily were evaluated for H. pylori eradication. Materials and Methods: A prospective cohort study was conducted at TaiZhou Hospital of Zhejiang Province between January and September 2024. Participants were divided into 2 groups: low-dose vonoprazan (QD, 20 mg once daily) and standard-dose vonoprazan (BID, 20 mg twice daily). The remaining drugs (colloidal bismuth pectin, clarithromycin, and amoxicillin) were the same for both groups, with a treatment duration of 14 days. Urea breath tests were performed 6-8 weeks post treatment. Results: In the intention-to-treat analysis, eradication rates were 89.2% (91/102) in the QD group and 88.9% (88/99) in the BID group, with no significant difference (P = .941). In the per-protocol (PP) analysis, eradication rates were 92.2% (83/90) in the QD group and 95.2% (79/83) in the BID group, also without a significant difference (P = .426). The incidence of adverse events was 8.9% in the QD group and 12.0% in the BID group (P = .497), respectively. The cost-effectiveness ratios were 2.59 for the QD group and 3.96 for the BID group in the PP analysis, respectively. Conclusion: Vonoprazan 20 mg once daily showed comparable efficacy to twice-daily dosing as part of a bismuth-based quadruple regimen for H. pylori eradication, with better cost-effectiveness, making it a promising option, especially in resource-limited settings. Cite this article as: Yan L, Lin R, Zhang Y, et al. Comparative effectiveness of vonoprazan dosing strategies in bismuth-based quadruple therapy for Helicobacter pylori eradication: A prospective non-inferiority cohort study. Turk J Gastroenterol. Published online February 13, 2026. doi: 10.5152/tjg.2026.25645.

Background: Fecal Microbiota Transplantation (FMT) is a therapeutic intervention involving the transfer of gut microbiota from healthy donors to individuals with dysbiosis, with the aim of restoring microbial homeostasis. Its efficacy is well established for the treatment of recurrent Clostridioides difficile infection. However, evidence supporting its use in small intestinal bacterial overgrowth (SIBO), particularly in patients who have undergone bariatric surgery, remains limited. Studies report that the prevalence of bacterial overgrowth after Roux-en-Y gastric bypass ranges from 29% to 53%, depending on the duration of postoperative follow-up. This study reports a clinical experience addressing this gap. Objectives: It was to report the clinical experience of FMT in a post– Roux-en-Y gastric bypass patient with SIBO and to develop an institutional FMT protocol for future clinical application. Methods: This prospective, open-label clinical experience was approved by the Research Ethics Committee of a tertiary care hospital, Fundação Hospital Adriano Jorge (FHAJ), under number 2.475.214, Manaus, Brazil. Ten post-bariatric patients under outpatient follow-up were screened. All presented recurrent diarrhea for at least three months despite a minimum of three prior antibiotic treatments. Inclusion criteria included a positive breath test for SIBO, altered functional stool analysis, or confirmed Clostridioides difficile infection by fecal toxin assay. Potential donors, preferably first-degree relatives, underwent clinical assessment and laboratory screening. Clinical and laboratory data were collected from both donor and recipient, including 16S rRNA fecal microbiota sequencing (Bioma4me™), bioelectrical impedance analysis, and habitual dietary intake assessment. Recipient evaluations were performed at baseline (T0) and 90 days after FMT (T1). The primary outcome was sustained resolution of diarrhea for at least 90 days following the procedure. Results: Of the ten patients screened, one met all inclusion criteria and underwent FMT. The procedure consisted of a single administration of 150 mL of fecal suspension diluted in 0.9% saline, delivered enterally via a nasoenteric tube positioned endoscopically in the distal alimentary limb. The treated patient achieved complete remission of gastrointestinal symptoms, maintained for more than 90 days. Conclusions: This clinical experience supported the development of an institutional FMT protocol and suggests potential benefit of FMT in selected post-bariatric patients with refractory SIBO. Nevertheless, larger studies with longer follow-up are required to establish the safety, efficacy, and reproducibility of FMT in this specific clinical setting. This study was funded by the Amazonas Research Foundation (FAPEAM).This clinical experience supported the development of an institutional FMT protocol and suggests potential benefit of FMT in selected post-bariatric patients with refractory SIBO. Nevertheless, larger studies with longer follow-up are required to establish the safety, efficacy, and reproducibility of FMT in this specific clinical setting. This study was funded by the Amazonas Research Foundation (FAPEAM). Grafical Abstract

Type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD) are increasing globally, with mitochondrial dysfunction being a core component in their development. While a 75g oral glucose tolerance test (OGTT) can be used to diagnose T2D, hepatic metabolic and mitochondrial dysfunction can be assessed using a 13C-methionine breath test (BT). We aimed to evaluate combining these tests for an efficient, non-invasive screening tool. On three study days, 26 subjects (11 [43.3%] female, 61± 16 years) subjects underwent either an OGTT, a 13C-methionine BT or both tests combined. Diagnostic outcomes of the individual and combined tests were compared using cumulative 13C percentage dose recovered (cPDR), plasma glucose concentrations and Homeostatic Model Assessment (HOMA)-indexes for insulin resistance and beta-cell function. In the combined test, cPDR90min was significantly lower (cPDR90min 2.3± 0.2% vs. 5.7± 0.5%; p< 0.0001), accompanied by a rightward shift of the 13C-increase towards later time points. When breath collection of the combined test was extended, cPDR145min (5.7± 0.4%) was practically identical to cPDR90min of the single test (p= 0.99). OGTT results, plasma glucose, and HOMA-indexes did not differ significantly between tests. Combining a 13C-methionine BT with an OGTT significantly impacts 13C-methionine kinetics, but not OGTT results. A potential mechanism includes a glucose-induced delay of gastric emptying. Combined testing may be feasible when time-adjusted measurements are used, potentially allowing simultaneous screening for both T2D and MASLD-associated mitochondrial dysfunction in clinical practice.

The rising antibiotic resistance has significantly reduced the efficacy of standard bismuth-based quadruple therapy for Helicobacter pylori (H. pylori) infections, particularly in patients with multiple eradication failures. This study evaluates a novel non-antibiotic triple therapy comprising Weisu granules, berberine hydrochloride, and Bio-Three-a probiotic formulation containing Clostridium butyricum TO-A, Enterococcus faecalis T-110, and Bacillus mesentericus TO-A-in treating H. pylori-positive functional dyspepsia (FD) patients resistant to conventional antibiotic treatments. A two-center retrospective analysis involved 48 FD patients who had previously failed at least two H. pylori eradication therapies. Participants underwent a 14-day course of non-antibiotic therapy, with primary endpoints being H. pylori eradication rate, assessed via 14C urea breath test, and secondary endpoints including symptom relief and adverse reactions. Successful H. pylori eradication was achieved in 72.9% (35/48) of patients. Symptom relief was observed in 77.08% of cases, with 43.75% achieving effective improvement and 33.33% marked improvement. Adverse reactions were mild, occurring in 8.3% (4/48) of patients, including abdominal distension, dry mouth, and nausea, all resolving spontaneously. The compliance rate was high at 91.67%. This study provides preliminary evidence supporting the use of non-antibiotic triple therapy as an alternative for managing H. pylori infections in FD patients resistant to conventional antibiotic treatments, demonstrating notable eradication rates and symptom relief with minimal adverse effects. Further research is warranted to explore its mechanisms, long-term efficacy, and potential integration into existing treatment paradigms.

Gastric disease in systemic sclerosis: Spectrum, challenges, and insights from a systematic literature review.

Serum pepsinogen (PG) levels are recognized biomarkers influenced by various factors, including lifestyle, Helicobacter pylori (H. pylori) infection status, and the presence of gastric mucosal lesions. However, whether baseline serum PG levels exhibit regional heterogeneity independent of concurrent gastric mucosal lesions has not been clearly established. The study aims to investigate the variability of baseline serum PG levels and identify potential influencing factors across China. Data were collected from individuals undergoing routine health checkups at twelve collaborating medical centers across China between October 2016 and October 2021. Serum pepsinogen I (PGI) and pepsinogen II (PGII) were measured and the pepsinogen I/II ratio (PGR) was calculated; gastroscopy with histopathology was performed to define gastric mucosal status. Detection of H. pylori infection status was performed using histology, serology, and/or breath tests. Lifestyle factors were obtained via standardized questionnaires. Regional differences and associated factors were evaluated using t-tests/ANOVA and multivariable linear regression (Stata 18). A total of 2902 individuals were included in the study. Of them, 2382 was classified as non-atrophic gastritis (NAG), and their regional distribution varied. Baseline serum PG levels significantly varied by regions, except between Southern and Central China. Factors such as H. pylori-positive (including prior eradication), high salt intake, and frequent fruit consumption were significantly associated with baseline serum PGR levels nationwide, with β value (95%CI) being - 2.75 (-3.33, -2.17), 1.66 (0.89, 2.44), and - 2.14 (-2.78, -1.51), respectively. Further analysis stratified by H. pylori infection status showed that both high salt and frequent fruit intake remained significantly associated with PGR. Baseline serum PG levels, independent of gastric mucosal lesions, exhibit significant regional variations across China. These variations are primarily associated with H. pylori infection status and dietary factors. Our findings suggest that region-specific and H. pylori-stratified PG cut-off values may be warranted for gastric cancer (GC) screening, pending prospective validation.

The diagnosis and treatment of Helicobacter pylori infection in children represent a major public health problem worldwide, and although prevalence in developed countries has declined, concern about antibiotic resistance continues to grow. This retrospective study aimed to analyze H. pylori infections in children under 15 years of age in Gipuzkoa (Basque Country, Spain) over a 25-year period and to describe patterns of primary and secondary antimicrobial resistance. All diagnostic tests received at a tertiary referral hospital between 2000 and 2024 were reviewed: urea breath test, gastric biopsy culture, string test, and stool antigen detection. Antimicrobial susceptibility testing was performed using the E-test gradient diffusion method. Out of 2855 children investigated, 26.9 were infected with H. pylori. Eradication control was performed in 62.5% (n = 480) of cases. Antimicrobial susceptibility testing was achieved in 96.5% out of the 400 isolates studied. All isolates were sensitive to amoxicillin and tetracyclines. Primary resistance to clarithromycin, metronidazole, and levofloxacin was 28.9%, 19.4%, and 8.9%, respectively, and secondary resistance was 38.7%, 29.7%, and 5.9%, respectively. H.pylori infection remains a challenge in pediatric patients, and the high resistance observed to clarithromycin and metronidazole makes it necessary to monitor the susceptibility of H.pylori and confirms the need for targeted treatment.

Hydrogen (H2) breath testing (BT) is used to diagnose small intestinal bacterial overgrowth (SIBO), and methane (CH4) to diagnose constipation. Recently, a third microbially derived gas, hydrogen sulfide (H2S), was added to BT and associated with diarrhea. Here, we assess a 3-gas BT nationwide, comparing the results to gastrointestinal (GI) symptoms. Consecutive subjects (N=6000) undergoing 3-gas at-home BT were asked to complete a symptom questionnaire. Substrate choice (glucose or lactulose) was at physician's discretion. H2, CH4, and H2S levels, and presence/absence of SIBO (≥20ppm rise in H2 within 90min), intestinal methanogen overgrowth (IMO) (≥10ppm CH4), and intestinal sulfide overproduction (ISO, defined here as ≥2ppm H2S) were compared with symptom severity. Gas interactions and symptoms' correlations were determined using machine learning (Uniform Manifold Approximation and Projection [UMAP]). A total of 3004 subjects who completed breath tests and primary questions were included. Bloating was the most common reason for BT. More subjects reported severe or very severe symptoms for bloating (52.9%) than diarrhea (17.8%), constipation (17.1%), or abdominal pain (17.1%). SIBO positivity was more common using lactulose (27%) versus glucose (7.3%). Higher H2 levels correlated with more severe diarrhea (P=0.031), and CH4 levels correlated with constipation (P=0.002). Higher H2S levels correlated with more severe diarrhea (P<0.0001), urgency (P=0.003), and abdominal pain (P=0.01). UMAP revealed that H2S levels increased symptom severity, and ISO (alone or with SIBO/IMO) drove greater diarrhea, urgency, bloating, and overall severity, with highest pain and severity in ISO alone. H2, CH4, and H2S are associated with unique symptoms: CH4 with constipation and H2S with diarrhea and a greater overall symptom severity. Glucose appears less sensitive than lactulose, suggesting it could potentially miss some symptomatic patients.

Revisiting drunk driving risk among individuals with alcohol use disorder using unsupervised learning: From clinical characteristics and neuropsychological performance to EEG data.

Suicidal ideation and driving under the influence of alcohol and marijuana among U.S. adults: Findings from the 2021-2023 National Survey on Drug Use and Health.